What is Endometriosis?

Endometriosis is a gynecological condition in which cells from the lining of the uterus (endometrial tissue) grow outside the uterine cavity in areas such as the ovaries, fallopian tubes and abdominal cavity.  Because of the excess tissue growth, irritation and pain can occur in the affected organs.  This irritation can develop into adhesions and/or scar tissue that can make it difficult for women with endometriosis to get pregnant.  Symptoms of endometriosis can vary depending on the stage and severity.

Common symptoms/indicators include:

• Pelvic/abdominal pain
• Painful periods
• Menstrual abnormalities
• Pain during intercourse
• Infertility
• Bowel symptoms such as bloating, diarrhea or constipation
• Urinary frequency or urgency

Often when a woman seeks treatment, it is because she is having difficulty getting pregnant.  30% to 50% of women who experience infertility are diagnosed with endometriosis.[1] Whether you are seeking treatment because of medical or fertility reasons, at RAD we provide a full spectrum of care for all stages of endometriosis.

How is endometriosis diagnosed?

Although symptoms are often key indicators of endometriosis, some women have no symptoms at all and the only way to conclusively diagnosis it is through a surgical procedure called a laparoscopy.  Laparoscopic surgery is a minimally invasive outpatient procedure, performed by making small incisions in or around the abdomen and utilizing a small camera instrument called a laparoscope to see in and around the reproductive organs.  This allows our two physician surgical team to determine if there is a presence of endometriosis and/or other conditions.

How is it treated?
During the laparoscopy, if endometriosis and/or adhesions are found, our physicians will remove as much of the endometriosis and scar tissue as possible.  Removal of the tissue should help alleviate pelvic pain, as well as improve the chances for achieving pregnancy naturally or with fertility treatments.  It also allows the physicians to stage your endometriosis to help determine your best course of action to achieve a pregnancy or stay pain free.  Further, Because of the minimally invasive surgical techniques used, the healing process is very quick, and patients are able to return to work and usual activities in about a week.

What if I am still having trouble getting pregnant post surgery?
For patients who continue to have fertility issues after surgery, we often suggest looking into other fertility treatment options, such as Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF).  (Link to IVF page).  Patients who do not wish to get pregnant after surgery will be put on medication to suppress their menstrual cycle, such as birth control pills, Lupron or Zoladex.  This is done because as long as a woman produces hormones and menstruates, endometriosis and pain may return over time.

Miscarriage

When a woman miscarries two or more times, the condition is referred to as “recurrent pregnancy loss.”[1] For couples dealing with even one loss, it is often a difficult and emotional journey. Seeking the proper medical diagnosis can help support a successful pregnancy outcome. At RAD, we understand the anxiety of not knowing the cause of your miscarriage and infertility struggles. For the 33% of patients who come to us with a prior diagnosis of “unexplained infertility,” we believe fewer than 5% of these cases to be truly unexplained. If you experienced an ectopic pregnancy (tubal pregnancy), or even one miscarriage in the past, it is our goal to determine the underlying cause of these issues and develop a treatment plan that is best for you. Although each patient’s situation is unique, some common causes of pregnancy loss with or without infertility include:
 

Solutions:

RAD has the expertise, technology and personalized care to treat simple and complex miscarriage and fertility diagnoses. In Vitro Fertilization, along with Pre-implantation Genetic Screening (PGS) and Pre-Implantation Genetic Diagnosis (PGD) can offer answers for couples with genetic and/or chromosomal abnormalities. Women with advanced maternal age can also benefit from IVF with PGD and/or PGS. Further, through precise diagnostic screening tests, we offer solutions such as laparoscopic and hysteroscopic surgery, where our physicians are able to identify and treat many uterine abnormalities. For more information about other treatment options or to schedule an appointment, call (302) 602-8822 or contact us.

Polycystic Ovarian Syndrome (PCOS)

What is PCOS?

Polycystic ovarian syndrome affects 5% of women and is one of the leading causes of infertility, as well as menstrual irregularity, and excessive hair growth (hirsutism).  The condition occurs when the ovaries produce excessive amounts of androgens, (male hormones, such as testosterone.)   Signs and symptoms of PCOS include:

• Irregular menstrual periods
• Infertility
• Excessive hair growth (face, abdomen, chest)
• Thinning hair
• Acne
• Ovarian cysts
• Weight gain
• Obesity

Changes in diet and exercise that result in weight loss can greatly improve the patient’s chance for pregnancy.  Obesity is common with PCOS; over 80% of women with PCOS are obese. Healthy lifestyle changes can improve the frequency of ovulation, lower diabetic risk and lower androgen levels.

Diagnosis

In order to properly diagnose PCOS, our physicians will request our clinical staff perform a physical examination.  A full physical evaluation is crucial because hormonal fluctuations can greatly influence the body in many ways.  Height, weight, blood pressure, heart rate, size of the thyroid glands, (an important metabolism regulator), exam of the heart, lungs, breasts and abdomen, and a survey of the skin are all taken into consideration.  Pelvic exams and ultrasounds can also provide insights into the causes of menstrual irregularities and/or fertility issues.

Treatment

Depending on each individual patient the treatment plan can vary greatly.  Factors to consider are whether or not the patient would like to get pregnant, weight, other health problems, etc.  For patients struggling with weight, we offer weight loss and lifestyle support to help patients increase their chance of pregnancy.
 
For patients seeking fertility care:
Ovulation may be induced with fertility medication such as clomiphene or gonadotropin.

 
If a pregnancy is not desired at the given time:
Birth control pills can aid in regulating menstrual periods, reducing hirsutism and acne, preventing endometrial cancer and preventing pregnancy.

For more information on PCOS:

Dr. Feinberg’s Book “Healing Syndrome O,” A Strategic Guide to Fertility, Polycystic Ovaries and Insulin Imbalance” (Purchase “Healing Syndrome O”)

Contact us here to schedule an appointment, or call us at (302) 602-8822

What causes pelvic pain?

There are a variety of issues that can cause pelvic pain, ranging from gynecological problems to bladder, bowel and pelvic concerns. Upon your initial appointments, our clinical staff performs a physical examination to determine if there are any visible signs of a problem. If non-gynecological problems are ruled out, some of the most common reasons for pelvic pain include:

• Endometriosis
• Adhesions
• Uterine Polyps
• Uterine Fibroids
• Ovarian Cysts
• Pelvic Inflammatory Disease

To determine the root of your pain, a typical work up includes a physical exam and blood work. Because many issues related to pelvic pain are not visible through imaging tests, minimally invasive surgery is often the next step in determining a conclusive diagnosis.

Tubal Ligation Reversal

Many women who decide they are done building their families choose to have their tubes tied as a form of contraception.  However we all know, the only constant thing in today’s world is change. Often women who have had this procedure approach our office with new hopes and dreams because they experience a personal, social, health, or financial change.  Are you in the same situation and considering reversing that decision? For patients who have had their tubes tied but are now looking to move forward and build or expand their family, tubal ligation reversal can make these dreams a reality!

This outpatient procedure involves restoring the fallopian tubes back to their original state in order to naturally achieve pregnancy.  Like all surgeries performed at RAD, our experienced two-physician team utilizes laparoscopic surgical methods that are less costly and minimize incision sites, resulting in a shorter healing and recovery process.

A variety of factors play a role in determining if a tubal reversal is right for you:

• Age
• Overall health
• The type of tubal ligation the patient received
• Length of the tube

Common tests to assess whether or not a patient is a good tubal reversal candidate include:

• A dye test (HSG) to make sure that the fallopian tube(s) are still attached to the uterus, and to determine the length
• A review of the OP report from the prior tubal ligation
• General labs (i.e. blood work)
• A semen analysis to ensure that the partners semen are healthy (if applicable)

If we find that tubal reversal surgery may not be the right method to achieve pregnancy, IVF is another treatment option. 

What is IVF?

What Financing and Payment Options are available?

Our practice is committed to offering you several affordability options. Our expert financial counseling team will also guide you to personalized and affordable financing options as you plan your care at RAD.

Fertility Preservation

The journey to building a family is not always easy, but with today’s advanced reproductive technologies, there is hope for women who have medical or personal issues that may compromise their ability to have children. Egg freezing, also known, as oocyte vitrification is procedure in which eggs are harvested from the ovaries and then frozen until the patient is ready to pursue a pregnancy at some point in the future.

Patients who might consider fertility preservation:

• Women undergoing treatment for cancer or other medical therapies that may affect reproductive health.
• Women who wish to defer having a child
• Family history of early menopause
• Increased maternal age

At RAD we are committed to providing you with the safest, most effective ways to preserve your reproductive health and family building options. To learn more about our fertility preservation program, contact us here or call us at (302) 602-8822.